How Does Medicare Advantage Enrollment Work?

Right now, the Medicare Open Enrollment Period is underway. This is the annual time, from October 15th through December 7th, when eligible seniors can sign-up for Medicare for the first time, and current participants who want to make changes to their existing coverage can do so.

There are different types of Medicare. Medicare Part A (hospital coverage) and Medicare Part B (medical services coverage) are together known as Original Medicare. This is because it’s what was originally offered when the government health insurance program was created in 1965.

Fast forward to 1997, and the government newly allowed Medicare enrollees to go beyond Original Medicare by enrolling in Medicare Advantage. Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. Consequently, its enrollment features are different from Original Medicare.

Medicare Advantage allows for program enrollees to receive their Medicare benefits through a private health insurance plan, and for private health insurance carriers to receive payments from the Medicare program to cover their beneficiaries’ medical costs. The main benefit is that Medicare Advantage plans offer more coverage options than traditional Part A and B coverage.

That said, a Part C participant still has to carry Part A and B to qualify, and they have to live in an area where their desired plan is offered. This can be not only a more expensive approach, as every Medicare Advantage plan comes with premium costs and potentially high out-of-pocket deductibles, but in many cases no such plans are even available, particularly in rural areas.

Enrollment dates and conditions can also be something to contend with. As mentioned above, enrollment in Part A and B are mandatory. This can be done during a senior’s initial seven-month enrollment period beginning three months prior to their 65th birthday month, or during Medicare’s annual Open Enrollment Period. Keep in mind that in 2019, Medicare Advantage may introduce a new Open Enrollment Period which you can learn more about by clicking this link.

Medicare allows for program participants to switch from Original Medicare to Medicare Advantage, and vice versa, during open enrollment, but there’s an important one-year deadline that applies when switching back to Original Medicare from a Medicare Advantage plan. Again, the main draw of Part C plans are that they offer additional coverage. Original Medicare participants, however, can always enroll in Part D prescription drug coverage and they have the option of purchasing supplemental coverage, known as Medigap, to pay for costs that Part A and B don’t cover.

Medigap is not available for Medicare Advantage enrollees, and after one year there’s no requirement that it will be available for Medicare Advantage participants who want to switch over to Original Medicare. If Medigap is offered at all, it could be extremely expensive, particularly for seniors with health conditions.

We know that you and your loved ones may have more Medicare questions. Don’t wait to ask us! You can also learn more on the Medicare website, including using the Medicare tool to research plan benefits, let us share four upcoming program changes to be aware of.

Feds waiving Medicare penalties for late sign-ups

More than 55 million Americans are enrolled in Medicare. Every year, after their 65th birthdays, men and women must enroll for Medicare Advantage and Part D prescription drug coverage between Oct. 15 and Dec. 7. But many forget to sign up, or they think they don’t have to because they have private insurance through the Affordable Care Act. They are mistaken, which can lead to a ton of headaches, not to mention big penalties.

There is good news. Medicare, the government-mandated health insurance program for older people, has temporarily suspended its rules and is waiving the late-enrollment fees for anyone who became eligible for Medicare Part B, which covers outpatient care and physician visits.

NPR and other media outlets reported a Medicare spokesman who said officials made the change because many people “did not receive the information necessary … through the marketplace to make an informed decision.”

People have been required to sign up for Part B within three months before or after turning 65 if they aren’t getting job-based insurance, or when their job-based health insurance ends if they are older than 65, according to Medicare rules. If someone younger receives disability checks, he or she can qualify for Part B after two years.

But those who qualify for Medicare will lose subsidies if they choose to remain in plans purchased on the federal or state exchanges under the rules of the Affordable Care Act. Until now, that caused premiums to skyrocket. One woman from St. Louis told NPR that her sister’s marketplace rate ballooned from $50 a month to $360 a month because she thought she didn’t have to enroll.

People age 65 and older who have a private insurance plan or had one they lost or canceled, as well as people who qualify for Medicare because of a disability, could qualify for the penalty waiver, or at least a reduction. They now have until Sept. 30 to request the waiver.

“This has been a problem from the beginning of the Affordable Care Act because the government didn’t understand that people would not know when they needed to sign up for Medicare,” Bonnie Burns, a consultant for the consumer group California Health Advocates told NPR. “Once they had insurance, that relieved all the stress of not having coverage and then when they became eligible for Medicare, nobody told them to make that change.”

For more information, visit the Medicare Rights Center at medicare rights.org.

Source: http://n.pr/2qX5nGu

Our experienced and trusted estate planning attorneys have been serving Treasure Coast families for decades, and Michael Fowler is one of only nine attorneys in the state of Florida who is double board-certified in wills trusts and estates and in elder law.  Contact us for your initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.

Finally, Congress is looking at Medicare for the chronically ill

Congressional lawmakers on both sides of the aisle are looking at improving Medicare. Believe it or not, there is a bipartisan bill in executive session that would help some Medicare providers better care for people with chronic illnesses.

The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 wouldn’t expand Medicare, however, it would allow providers more flexibility in the way they help people with such conditions, who make up the government program’s most expensive and most necessary recipients. The bill is a major step by leaders who until now had not considered that people with chronic conditions may require services that Medicare does not now offer.

The bill’s sponsors are Sens. Orrin Hatch (R-UT), Ron Wyden (D-OR),  Johnny Isakson (R-GA) and John Warner (D-VA).

Forbes outlines the bill’s mission well.
“CHRONIC would expand the use of telehealth, extend and expand a home-based medical practice experiment called Independence at Home, and improve the Medicare appeals process for people in risk-based insurance plans such as Special Needs Plans (SNPs). But the biggest changes would apply to the care provided by managed care programs.

One would expand the use of those special needs plans, which are explicitly aimed at people with chronic conditions and high medical needs. Some of these programs already provide supports and services as part of their benefit packages but they remain relatively small.

The other would give Medicare Advantage plans important new flexibility to offer social supports and other non-medical services to their members. About one-third of Medicare enrollees are in MA plans.”

Right now, Medicare provides the same services to everyone, regardless of their level of health. As the Forbes article notes, “fitness benefits are OK, but home-delivered meals or medical transportation are not. For many older adults with chronic conditions, a ride to the doctor or a hot meal to stave off malnutrition are crucial to their well-being.”

Medicare is, as always, an important issue for those over the age of 65. It’s even more pressing for men and women who suffer from chronic conditions and need Medicare to live productive and healthy lives.

Source: http://bit.ly/2toZDD5

Our experienced and trusted estate planning attorneys have been serving Treasure Coast families for decades, and Michael Fowler is one of only nine attorneys in the state of Florida who is double board-certified in wills trusts and estates and in elder law.  Contact us for your initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.

Trump’s budget proposal protects entitlement programs – for now

President Donald Trump’s first federal budget proposal includes cuts to the U.S. Department of Health and Human Services, including 18 percent, or $15.1 billion next year.

The Los Angeles Times reports that the biggest cuts within the agency are to the National Institutes of Health, which would see its budget go down $5.8 billion to $25.9 billion.

The Department of Health and Human Services is the largest agency within the federal government. It includes the Medicare and Medicaid programs, both with help many of Florida’s elderly maintain a living, provide medical services and in some cases, help pay for or supplement nursing home care.

The good news is, Trump’s current budget proposal does not include Medicare, Medicaid or any other federal entitlement programs, although they consume the majority of agency’s budget. The president has said that he will protect Medicare, Medicaid and Social Security.

Earlier this year, speaking on Fox News’ “Sunday Morning Futures,” U.S. Secretary of the Treasury Steven Mnuchin said the administration was “not touching” entitlement programs at this time. The budget proposal must be approved by Congress.

“So don’t expect to see that as part of this budget, OK,” Mnuchin said of the programs,” he said on the program.  “We are very focused on other aspects and that’s what’s very important to us. And that’s the president’s priority.”

Whatever happens with the Trump budget request or future federal budgets, there has been talk for years about rolling back Medicare, Medicaid and Social Security. That can be worrisome for an aging population, especially Baby Boomers who spent their lives working, paying taxes and contributing to society.

Anyone who owns property, including a house or car, should have an estate plan in place that includes long-term care planning, trusts and other investments that can provide income if needed. Don’t rely on the government to care for you when you need help. Talk to an estate planning attorney today with experience in elder care, and give yourself peace of mind so you are prepared if entitlement programs are ultimately cut now or down the road.

Our experienced and trusted estate planning attorneys have been serving Treasure Coast families for decades, and Michael Fowler is one of only nine attorneys in the state of Florida who is double board-certified in wills trusts and estates and in elder law.  Contact us for your initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.

The National Health Law Project looks at the impact of the Medicaid pricing structure

A recent study by the National Health Law Project found that efforts by federal lawmakers to reduce Medicaid funding will put the lives of 74 million people at risk.

On the state level, the expansion of Medicaid programs, however, has made more resources available to help people, the study found, including the elderly, have access to the services they need for good health and the ability to live independently.

Medicaid is administered by the states, combining state and federal dollars to provide health services to low-income people, including children and their caretakers, pregnant women, the disabled, the blind, and those over the age of 65 who qualify. The coverage can vary by state, but the federal government requires it to include doctor’s visits and hospital expenses, among other services.

As of January, 31 states had expanded their Medicaid programs, the report says. Florida was not among them.

The states that did, though, initially received 200 percent federal reimbursement for the costs of these new enrollees. Over time, the federal share will drop to 90 percent. Congress is considering reducing federal funding below 90 percent.

Whatever lawmakers decide, Medicaid is often crucial in helping cover the costs of long-term care. The average cost of a nursing home or assisted-living facility in Florida can exceed $100,000 a year. Medicare only covers those costs for a limited time in most cases. It’s crucial that estate planning ensure factor in eligibility for Medicaid benefits, or else retirement assets – or your entire estate – could be consumed by long-term care costs.

Medicaid planning is a critical part of a comprehensive strategy to provide necessary care for seniors without dissipating assets that could be used for retirement or the needs of a healthy spouse, or passed on to loved ones. But qualifying for the Medicaid benefits that can cover long-term care costs is complicated, and any number of missteps could make a difficult financial situation even worse.

Since Medicaid is a needs-based program designed to provide medical care and assistance for low-income individuals, eligibility for the benefits that can pay for long-term care is based on your available assets. Medicaid planning involves structuring your assets and liabilities in such a way that they are excluded from the calculations used to determine Medicaid eligibility.

Our experienced and trusted estate planning attorneys have been serving Treasure Coast families for decades, and Michael Fowler is one of only nine attorneys in the state of Florida who is double board-certified in wills trusts and estates and in elder law.  Contact us for your initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.

 

Medicare, Medicaid and long-term care

People are living longer and healthier than they ever have before. That is wonderful news for all of us as we put a focus on our health, vitality and the belief we are as young as we feel.

But at some point, everyone must consider a long-term care plan in the event they become physically or mentally incapacitated. Currently, one in five Americans experiences the need for long-term care, and as baby boomers age, that number is anticipated to increase substantially.

People of all ages cannot count on Medicare to cover them in the event they need nursing home care.

For example, Medicare covers temporary skilled or rehabilitative care for those older than 65, paying for up to 100 days in a facility. But, that is only if a patient has spent three days in the hospital first. Medicare usually does not cover long-term nursing home care.

Additionally, most health insurance plans do not cover nursing home care at all. Medicaid, if you are low-income and qualify, can help pay for nursing home care. However, not all nursing homes accept Medicaid as payment for long-term care.

There are many potential bumps in the road when it comes to long term care. That’s why it is crucial that you have a long-term care plan in place long before you ever need such services. Many planning experts say the best time to obtain long-term care insurance is 20 to 25 years before you need it. Your premiums will be lower if you start early. You’ll have to choose the daily benefit amount you want when you purchase your long-term care policy – the average daily cost of a private room in a Florida nursing home is $265, according to the Genworth 2015 Cost of Care Survey.

A majority of people choose to begin receiving their long-term care benefits once their Medicare coverage is exhausted, but you can delay the start of benefits for any length of time. Many people select a five-year benefit period, since studies show the average long-term care need is 2.5 years.

Perhaps most importantly, make sure your policy provides enough coverage to make your daily benefits sufficient when you need them years from now. Contact an experienced long-term care planning attorney today.

Our experienced and trusted estate planning attorneys have been serving Treasure Coast families for decades, and Michael Fowler is one of only nine attorneys in the state of Florida who is double board-certified in wills trusts and estates and in elder law.  Contact us for your initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.

Guidelines for Choosing a Medicare Advantage Plan

Guidelines for Choosing a Medicare Advantage PlanOpen enrollment for Medicare happens once a year, typically beginning the first of November and ending the first week in December. Many people are opting for a Medicare Advantage plan rather than original Medicare. Medicare Advantage plans are privately operated plans and work like traditional health insurance. Here are some guidelines for choosing a Medicare Advantage plan:

Find the plans in your area. To find Medicare Advantage plans for where you live, go to medicare.gov and search for the Medicare Plan Finder. SHINE (Serving Health Insurance Needs of Elders) is a free program where specially trained volunteers can assist you with your Medicare, Medicaid, and health insurance questions. It is offered by the Florida Department of Elder Affairs and your local Area Agency on Aging. In addition, our local area agency on aging has a toll-free elder helpline number: 866-684-5885

Compare benefits and costs. Think about the services you use most and how often you use them, then click on the “Benefits” tab for each plan to view what each plan offers and the cost. Remember that lower premiums usually mean higher deductibles and co-pays.

HMO or PPO? Most Medicare Advantage enrollees opt for HMO (health maintenance organizations) plans over PPO (preferred provider organizations) plans. HMOs typically cost less but require you to choose a primary care doctor to coordinate your care and will not pay for doctors outside their network. PPOs allow you to choose any doctor you want, and offer costs savings for choosing an in-network doctor.

Keeping your current doctor. If you want to keep your current doctor, check with his or her office to see if they are part of a Medicare Advantage plan network.

Get coverage for the drugs you take. After you narrow your choices, re-do your search and enter the names of the medications you are currently taking. The new results will show only the plans that cover those drugs. If some of the plans you chose earlier are still on the list, these are probably good options for you.

If you’d like to learn more about how we can help you with your long-term care and Medicaid planning, please contact us for your initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.

6 Ways to Help Elderly Parents With Their Finances

6 Ways to Help Elderly Parents With Their FinancesProbably one of the most difficult tasks that adult children with elderly parents face is when and how to step in to help a failing parent with their finances. Children who notice signs of financial inattention – bills unpaid, papers piling up, utilities cut off – can use these tips to offer assistance:

Offer to help pay bills. Offer to sit with a parent once a month to take care of the bill paying. This allows them to still maintain control of their accounts while ensuring all the bills are handled.

Get online access. By getting online access to a parent’s bank accounts, children can track expenditures and know right away if unusual transfers or payments are being made and can question those.

Sort accounts. See if you can leave your parent in charge of the checking account while you take control of the investment accounts, so smaller amounts are at risk.

Medicare supplemental coverage. If your parents are on Medicare, you should review with them their supplemental coverage, including gap coverage (if they have chosen this option) and their prescription drug plan. Many seniors are uncomfortable navigating the Internet for choices, but the Medicare website (www.medicare.gov) has a useful plan finder you can use to navigate the many choices.

Retirement account distributions. If your parents have IRAs and other qualified retirement accounts that require them to take a minimum distribution once they reach the age of 70 ½, they must do so each year by Dec. 31 or face up to a 50 percent penalty. You can contact the plan administrators to set up an automatic deduction every year to avoid this problem.

Estate planning. Your parents should have an up-to-date will, powers of attorney and other estate planning documents in place already. If they do not, it would be wise to schedule an appointment for you and them with a Florida estate planning attorney, many of who offer a free initial consultation to help you ascertain what is needed.

At The Estate, Trust and Elder Law Firm, P.L. we help our Treasure Coast clients develop and implement comprehensive estate planning strategies personally tailored to their unique situation, needs, and goals.   Contact us for your initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.

Is In-Home Care the Right Choice for You?

Is In-Home Care the Right Choice for You?Baby boomers have always been categorized as an adventuresome generation, but when it comes to long-term care, most agree they want to stay at home.

A recent AARP study showed that 90% of us want to grow old at home; here are some of the considerations for determining when in-home care is a viable option:

Personal limitations. These are not only physical limitations but financial as well. While the costs of in-home care are usually less than assisted living or a nursing home, most of those will come out of your pocket since Medicare does not typically pay for home care that isn’t medically necessary (following a hospital stay), personal care or 24-hour care. Medicaid can cover home-health assistance depending on if you meet eligibility requirements.

Home limitations. Sometimes the home you lived in for decades becomes unlivable if you are unable to navigate safely. You may want to consider some renovations to make it easier for you to move about or even moving to a single-story residence if you live in a house with multiple levels.

Community support. One argument for assisted living is that the elderly have access to more social activities and health aid when they move to an assisted living facility. Fortunately, many businesses have sprung up in recent years that can provide many of these services in your own home, including personal care assistants, help for shopping and cleaning, and even doctors who will visit you in your home.

If you’d like to learn more about how we can help you with your long-term care and Medicaid planning, please contact us for your free initial consultation at one of our conveniently located offices in Fort Pierce, Stuart, Port St. Lucie, Vero Beach, and Okeechobee.